Network Management & Contract Analyst

Capital District Physicians Health Plan Inc; Buffalo (NY); Remote; USD 62,000 - 107,000; Full time

Benefits offered by this job

Remote work possibility

Job summary

Capital District Physicians Health Plan Inc. seeks a professional to develop and maintain provider networks, perform network analysis, and negotiate contracts aligned with corporate strategy.

The role requires understanding pricing methodologies, regulatory requirements, and regional market dynamics to support provider reimbursement programs and product lines.

Qualifications

• Six (6) years of provider network reimbursement or related experience required.
• Two (2) years of experience directly performing provider contracting or reimbursement analysis required.
• Demonstrated experience of provider reimbursement methodologies.
• Ability to draft, interpret and apply contractual language.
• Technical skills including modeling and financial analysis.
• Understanding of medical care delivery, industry trends, and regional market dynamics.
• Strong, persuasive, and effective verbal and written communication skills.
• Knowledge of health care products and services offered to members.
• Excellent problem-solving skills.

Responsibilities

• Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business.
• Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies.
• Identifies, investigates, and analyzes issues and questions. Collects and interprets data and information to support provider network contracting and administration activities.
• Effectively prepares and presents information, findings, and recommendations to internal and external stakeholders.
• Serves as liaison with assigned stakeholders to identify and coordinate provider network contract and administration work items.
• Engages in provider contract negotiations. Works routinely and directly with providers, clinical, and operational leadership.
• Assist in the preparation of provider contracts, amendments, and communications.
• Maintains knowledge of relevant legislative and regulatory mandates to ensure compliance.
• Responds to and resolves inquiries from providers and colleagues related to provider network contracting and administration.

Skills

Provider reimbursement

Contract analysis

Financial modeling

Communication skills

Industry knowledge

Problem solving

Education

Bachelor's degree

Tools

Regulatory knowledge

Job description

Job Description

As a professional within the network contracting and administration team, the incumbent will contribute to the development and maintenance of provider networks. This position is accountable for performing provider and network analysis, evaluating provider reimbursement, and negotiating provider contracts in accordance with corporate strategy. As such, the role requires a multifaceted understanding of provider types, applicable legal and regulatory requirements, pricing methodologies, industry and regional provider impacts & trends, provider reimbursement and related programs, and product lines.

Summary

As a professional within the network contracting and administration team, the incumbent will contribute to the development and maintenance of provider networks. This position is accountable for performing provider and network analysis, evaluating provider reimbursement, and negotiating provider contracts in accordance with corporate strategy. As such, the role requires a multifaceted understanding of provider types, applicable legal and regulatory requirements, pricing methodologies, industry and regional provider impacts & trends, provider reimbursement and related programs, and product lines.

Essential Accountabilities

• Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business. Serves as provider network contracting and administration subject matter expert for assigned areas.
• Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies.
• Identifies, investigates, and analyzes issues and questions. Collects and interprets data and information to support provider network contracting and administration activities. Applies applicable contract terms, regulatory and legal requirements, and other information to produce accurate and actionable analysis.
• Effectively prepares and presents information, findings, and recommendations to internal and external stakeholders.
• Serves as liaison with assigned stakeholders to identify and coordinate provider network contract and administration work items. Executes initiatives; tracks, forecasts and reports on progress including qualitative and quantitative measures.
• Engages in provider contract negotiations. Works routinely and directly with providers, clinical, and operational leadership.
• Assist in the preparation of provider contracts, amendments, and communications.
• Maintains knowledge of relevant legislative and regulatory mandates to ensure compliance.
• Responds to and resolves inquiries from providers and colleagues related to provider network contracting and administration. Leads issue resolution with internal and external stakeholders.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Minimum Qualifications

• Six (6) years of provider network reimbursement or related experience required. Or a Bachelor's degree in Health Care Administration or relevant field.
• Two (2) years of experience directly performing provider contracting or reimbursement analysis required.
• Demonstrated experience of provider reimbursement methodologies.
• Ability to draft, interpret and apply contractual language.
• Technical skills including modeling and financial analysis.
• Understanding of medical care delivery, industry trends, and regional market dynamics.
• Strong, persuasive, and effective verbal and written communication skills.
• Knowledge of health care products and services offered to members.
• Excellent problem-solving skills.

Physical Requirements

• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

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Equal Opportunity Employer

Compensation Range(s)

Grade E3: Minimum $62,400 - Maximum $106,929

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.